Provider Demographics
NPI:1508520115
Name:ILAMAE PRICE LLC
Entity Type:Organization
Organization Name:ILAMAE PRICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ILAMAE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-551-2799
Mailing Address - Street 1:612 MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:GA
Mailing Address - Zip Code:30268-1149
Mailing Address - Country:US
Mailing Address - Phone:140-455-1279
Mailing Address - Fax:678-834-5529
Practice Address - Street 1:612 MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:GA
Practice Address - Zip Code:30268-1149
Practice Address - Country:US
Practice Address - Phone:140-455-1279
Practice Address - Fax:678-834-5529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory